Gallstones often cause a sudden, intense pain in the upper right abdomen, just under the ribcage. But here’s what surprises most people: up to 80% of people with gallstones never develop symptoms at all. The stones sit quietly in the gallbladder for years, sometimes forever. It’s the other 20% who experience what’s commonly called a “gallbladder attack,” and knowing what that feels like can help you recognize it quickly.
What a Gallbladder Attack Feels Like
The hallmark symptom is a pain known as biliary colic. Most people describe it as intense, sharp, cramping, or squeezing. It typically hits the upper right side of your abdomen, right under your ribs, though some people feel it more in the center of the abdomen just below the breastbone. The pain often radiates to other areas: your right shoulder, your back between the shoulder blades, or both.
This isn’t a dull ache that builds slowly. It comes on suddenly and intensifies rapidly, usually reaching full strength within minutes. A typical episode lasts several hours, which is one of the key features that sets it apart from ordinary stomach discomfort. Many people experience it shortly after eating, especially after a large or fatty meal. When you eat fat, your gallbladder contracts to release bile for digestion. If a stone is blocking the exit, that contraction produces intense pressure and pain.
Nausea and vomiting frequently accompany the pain. Some people also notice bloating or a general sense of fullness that feels different from normal indigestion.
How to Tell It Apart From Indigestion
Gallstone pain and indigestion can both show up after a heavy meal, so it’s easy to confuse them at first. A few differences help you tell them apart.
- Location: Indigestion tends to cause a burning sensation behind the breastbone with bloating and burping. Gallbladder pain is more of a sharp, localized pain under the right ribcage that can spread to the shoulder or back.
- Duration: Indigestion usually eases with antacids or within an hour or so. Gallstone pain lasts several hours and does not respond to over-the-counter antacids.
- Predictability: Indigestion is closely tied to eating. Gallbladder attacks often start after a meal but can also strike unpredictably, even when you haven’t eaten recently.
- Accompanying symptoms: Indigestion comes with heartburn, bloating, and fullness. Gallstone episodes can bring nausea, vomiting, fever, chills, or jaundice, none of which are typical of simple indigestion.
If antacids don’t touch the pain and it’s been going on for more than an hour or two, gallstones are worth considering.
Signs of Gallbladder Inflammation
Sometimes a gallstone doesn’t just cause temporary pain. If a stone stays lodged in place, the gallbladder itself can become inflamed, a condition called acute cholecystitis. The symptoms overlap with a standard gallbladder attack but are more severe and persistent.
With inflammation, the pain doesn’t fade after a few hours. It sticks around, and the area under your right ribs becomes extremely tender to the touch. You may notice that it hurts more when you take a deep breath, because the inflamed gallbladder shifts as your diaphragm moves. Fever, nausea, and vomiting are common. This is a situation that needs prompt medical attention, as an inflamed gallbladder can develop serious complications if left untreated.
Symptoms of a Blocked Bile Duct
Gallstones can also slip out of the gallbladder and get stuck in the bile duct, the tube that carries bile from the liver to the intestine. When this happens, bile backs up and a pigment called bilirubin builds in your bloodstream. The symptoms look different from a typical gallbladder attack.
The most recognizable sign is jaundice: a yellowing of the skin and the whites of the eyes. Your urine may turn noticeably dark, while your stools become pale or clay-colored. This happens because bilirubin, which normally gives stool its brown color, can’t reach the intestine. Many people also develop itchy skin, which can be surprisingly intense and widespread.
The pain pattern changes too. Instead of the sudden, cramping pain of biliary colic, a duct blockage tends to produce a dull, persistent ache in the upper abdomen that gradually increases over several minutes. Fever and chills, loss of appetite, nausea, and unexplained weight loss can accompany it. A blocked bile duct raises the risk of infection, so these symptoms call for prompt evaluation.
When Gallstones Cause No Symptoms
Most gallstones are discovered by accident during imaging for something else entirely. Research published in the Cleveland Clinic Journal of Medicine found that about 80% of people with gallstones never develop symptoms or complications. These “silent” gallstones generally don’t require treatment. Of those who have them, roughly 20% eventually develop gallstone-related symptoms over the course of their lifetime. There’s no reliable way to predict who will become symptomatic and who won’t, which is why doctors typically recommend a watch-and-wait approach for stones found incidentally.
Red Flags That Need Immediate Attention
Most gallstone episodes, while painful, resolve on their own within a few hours. Certain combinations of symptoms, however, suggest a complication that needs emergency care. Severe abdominal pain lasting longer than a few hours, especially when paired with a high fever, chills, or jaundice, warrants immediate evaluation. Persistent vomiting that prevents you from keeping fluids down is another reason to seek urgent help. These signs can indicate an infected gallbladder, a blocked bile duct, or inflammation of the pancreas, all of which can worsen rapidly without treatment.